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Home My WebLink AboutBuilding Permit #479 - 371 PLEASANT STREET 3/16/2009Permit NO: Date Issued: I` `(/ ` 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page LOCATION �,3 r%1 l e -Ajar) f V rec - l - Print PROPERTY OWNER Print MAP NO.: A 9,S PARCEL: TYPE AND USE OF BUILDING ZONING DISTRICT: HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT oy � Residential T s ❑ New Building ❑ Addition ❑ Alteration TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration ❑Qrie family ❑ Two or more family No. of units: ❑ Industrial Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Commercial ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: C( I)Si- JUl e4t nn Phone: 1)F (J J Address: �3 �/ Pbllj i A /UCt Ado ow, Ul CONTRACTOR Name:NuIld Oajfrjc&V eoofia Phone: M Address: ZDO SWiw s A Ordove,, /yl/ -i Supervisor's Construction License: q 9 3 SPi Exp. Date: /o,1/(0 Home Improvement License: /d YRO q Exp. Date: i ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASE�ON $125.00 PERS. F. Total Project Cost S a9lo o , �� FEES -; & Check No.:Receipt No.: Page I of 4 TYPE OF SEWERAGE DISPOSAL Art ❑ Swimming Pools 111-1Tanning/Massage/Body g Public Sewer Tobacco Sales ❑ Food Packaging/Sales [I❑ Well ❑ Permanent Dumpster on Site LlPrivate (septic tank, etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty nd Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH CO AMENTS DATE REJECTED DATE APPROVED ❑ ❑ DATE REJECTED El FIRE DEPARTMENT - Temp Dumpster on site yes, Fire Department signature/date COMMENTS Ci DATE APPROVED no Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA — (For department use Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC. Jan2006 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 Location &::� i No. Date ' NORTH TOWN OF NORTH ANDOVER VP Certificate of Occupancy $ �' Building/Frame Permit Fee $kwu Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 0 * . " Building Inspector a d O W u bG O w v cn O R"' z A p w �°° O c4 E C U G w a � U W 9 '' ono p p � O W W �°° m F U a �o 00 C W A cn u O cn O F=4 E Ma CD ZIDN C cc O D7 co m cm m 0 cm c C N CD t r.+ O Z 0 cz O3 0 CD C2 Z � CL O y � C cm co i Q .� y W FE m m L- C3 CD H CL CD 3 .o CD C O CD env o a CL cma ca c o � � Cc M w -j -0 CL cm CD C** Z m CD CL C.3 y � C LLI YI N W W W N c c ® c C2 C y _O C ca V C. C O N p dki= i C2 m .44 r La CD CD0 d Go O m t .oma o 0 �jt3Amc V: N m L S 2^ 3 c :MD. W� c D T m H O N CD �: : s CD 'J CL :mOf CD oao !7c mymc H D o m o H WC Ori... flt LL O •N •.. C +-� *C.L O ac"E C ; vm IS Co.,ti omc y C. O O *. E Ma CD ZIDN C cc O D7 co m cm m 0 cm c C N CD t r.+ O Z 0 cz O3 0 CD C2 Z � CL O y � C cm co i Q .� y W FE m m L- C3 CD H CL CD 3 .o CD C O CD env o a CL cma ca c o � � Cc M w -j -0 CL cm CD C** Z m CD CL C.3 y � C LLI YI N W W W N Massachusetts - Depa •hncnt of Public SafetN Board of Buildinl- Regulations and Standards P Specialty Construction Su ervisor S ecialt License License: CS SL 99358 Restricted to: RF,WS DAVID CASTRICONE 31 COURT STREET NORTH ANDOVER, MA 01845 (luuwissi�uicr Expiration: 12/16/2011 Tr»: 99358 (� 9211 'C�JOr�t.�rtOrNUIlLGUG ✓G�lxwatYiudeltl Board of Building Regulatio s and Standards y _ HOME IMPROVEMENT CONTRACTOR Registration: 104569 Expiration: 7/14/2010 Tr# 270265 Type: Private Corporation DAVID CASTRICONE ROOFING, SIDING 8 David Castricone 20D SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 Administrator h Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM tAORTfy O L Y�. n # .� COG NI[ry� WN F Are '7A SArui 15�� In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in /at: � Z- INC— Facility location'j� r Signature of Applicant s l n l'>qi Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. sbi I�r DAVID CASTRICONE CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET, SUITE 226, NO. ANDOVER, MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6747 In Haverhill 978-374-7314 Uwe the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and conditions, on premises below described: Owner's Name....../. 44.c_ /7 J t................................................................ Te hone #....("03...... .. ....................Job Address....sj/City................. Statef../.Q...�� ....... Specifications: ✓trip existing shingles t�pply new drip edge to all edges. N . ' ...................................................................................................................................................................................................................... i/Apply feet ice and water shield membrane to bottom edges of house. 3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. .................................................................................................. :ripply felt paper underlayment. A nstall ridge vent to _ 40roof using shingles with a 3 y year warranty. .......................................................................................................................................... wCbunterflash chimney. New vent pipe flashing. 4-) gal disposal of all debris. ........................................................................................................................................................................... Areas) to be worked on: R .... .... ......pQ... ..... ....... .... ..........`._._Jj�.'.\.t:.lr;.:l:.....�(7.. f:..l.'......,i�A.t7..........2.J�...�.5 .. ........sS I... .. X)...0 ........................... /Y e t cz.......r..l.:.......h..c,. 5...................................................................................................... ...................................................................�y...................... .gip ............................................................................................................ Roof board replacement if necessary @ Lp /sheet or /foot ......................................................................................................................................................................... ....................................... Two Year Workmanship Warranty (Not Transferable) NF"anufacturer's Warranty as specif y mati The contractor agrees to perform the work and furnish the materials specified above for the SUM $...,,.Y 1/—.Q .......... ..... Payable............................. on ................................. Payable ............................. on .............. ....................Balance payable on completion of job , Owner or Owners are not responsible for Property Damage or Liability while job is in operation. Contractor is not responsible for any damage to the interior of property, including pre-existing conditions (i.e. water stains, crumbling plaster, exposed nails) or conditions resulting from application of materials specified above (i.e. objects coming loose from walls, crumbling plaster, exposed nails, dust in attic or other living spaces). Items in attic may need to be covered by homeowner. All materials are property of contractor. Any dumpster placed by contractor is for his use only. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation as requested by contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid, immediately due and payable. It is agreed that, if permitted by law, contractor shall be paid by the owner(s) all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid that shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith. It is further agreed that this contract may be assigned by contractor, and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they rue) the owners(s) of the above mentioned premises and that legal title thereto stands of record in his (their) names(s). There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is the contract dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration,. One Ashburton Place, Room 1301, Boston, MA 02108 Tel: 617-727-8598 Any and all necessary construction -related permits shall be obtained by the Contractor. Any Owner'who secures his own construction - related permit or deals with unregistered contractors is excluded from the Guaranty Fund provisions of MGL c. 142A. Approximate starting date of work ................................................ Completion date ......................................................... Receipt of a copy of this contact is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Owner has three business days to cancel this contract and incur no penalty (see notice of cancellation). IN WITNESS WHEREOF, the parties have hereunto signed their names this .................. day of ........ .l..f'............. 20.....�.. Accepted: r' . / . Signed .......`.:...L ......... . r. ......:...:...::`.:.�.^�....................... Owner V Signed............................................................................. Owner ........... David Castricone, President ACQRQ. CERTIFICATE OF LIABILITY INSURANCE10/3/2008 DATE(MMIDD/YYYY) PRODUCER Phone: 508-651-7700 Fax: 508-653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC -Commercial Lines ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Natick MA 01760 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED David Castricone Roofing & Siding Inc 200 Sutton St Suite 226 North Andover MA 01845 CnVFRARGC INSURERS AFFORDING COVERAGE I NAIC # INSURER A: i:Lat-iop Inaurance 40274 INSURERB:T e Insurance Co of State PA INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. im POLICYNUMBER POLICYEFFECTIVE DATE (MANE) D1YYA POUCYEXPIRATION nATrtmm/nn/yyj LIMITS$ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACHOCCURRC-NCE CLAIMS MADE OCCUR PREMISES Eaoccurence $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PRO- _CT LOC PRODUCTS -COMP/OPAGG $ A AUTOMOBILE LIABILITY ANYAUTO 08MMBBTNKT 8/1/2008 8/1/2009 COMBINED SINGLE LIMIT (Eaaccldenl) $ ALLOWNEDAUTOS X SCHEDULEDAUTOS BODILY INJURY (Par person) $ $250,000 X VIIREDAUTOS }( NONaWNEDAUTOS BODILYINJURY (Par acdclaru) $500,000 5 0 0, 0 0 0 PROPERTY DAMAGE (Peraocldarn) $ 100,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ $ AUTOONLY: AGG EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE EACHOCCURRENCE $ AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' UABILITYYUW WC5877756 9/23/2008 9/23/2009 X WCS TU- OTH E.L. EACHACCIDENI $100,000 ANY PROPRIETOR(PARINER(EXECUTIVE OFACERIMEMBER EXCLUDED? E.L.DISEASE . EA EMPLOYEE $100,000 II yyes describe undar SPECIAL PROVISIONS below OTHER E.L DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SP ECIAL PROVISIONS CERTIFICATE unl nrn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY Y,IND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001108) o ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information -p Please Print Legibly Name (Business/Organization/Individual): l.0 {#V 1D C ASTl21 PLE n0 O F l NCT S 1D I N 6- i N L Address: A -AD Sy TTotJ 5 -Tau' --1` `Ju 1'-E. 2 2.6 City/State/Zip:_NA 01949 Phone #: 91Z -(p93-31-1-0 Are you an employer? Check the appropriate box: 1. ® I am a employer with 8 4.0 I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. F_1 I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.1 required.] 5. E] We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' insurance Type of project (required): 6. ❑ New construction 7. EJ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. E] Electrical repairs or additions I LE] Plumbing repairs or additions 12. oof re ai 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. '$Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Sy raj (L Co O k SixtCPA _ Policy # or Self -ins. Lic. #: WC 5 8 1. 1 t 5 6 Expiration Date: 91 a, � 1 p QJ nn j� __ T Job Site Address: h l r%/ Nti l �I iY City/State/Zip: A4\j, t/ A4 &d 1� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under them% e pain�sand penalties of perjury that the information provided abov is true and correct Signature: � �«�»✓ . C Date: Phone #: 9_) $ 6 D 3 r3 q Ab use only. Vo not write in this area, to City or Town: or town officiaL Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Phone #: